CPT Code 21244

CPT code 21244 is for the reconstruction of the lower jaw, detailing the specific medical procedure for accurate billing and insurance purposes.

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What is CPT Code 21244

CPT code 21244 is for the surgical procedure involving the reconstruction of the lower jaw. This code is used by healthcare providers to document and bill for the specific service of rebuilding or repairing the lower jaw, often necessary due to injury, disease, or congenital defects.

Does CPT 21244 Need a Modifier?

For CPT code 21244 (Reconstruction of lower jaw), the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.

2. Modifier 52 (Reduced Services): Applied when the procedure is partially reduced or eliminated at the physician's discretion. This might occur if the full reconstruction was not necessary or completed.

3. Modifier 53 (Discontinued Procedure): Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This could be relevant if multiple procedures are performed that are not typically reported together.

5. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure. This is relevant in complex reconstructions where collaboration is necessary.

6. Modifier 66 (Surgical Team): Used when a team of surgeons is required to perform the procedure due to its complexity. This modifier indicates that the procedure necessitated a team approach.

7. Modifier 76 (Repeat Procedure by Same Physician): Indicates that the same physician performed the procedure more than once on the same day. This might be relevant in cases where additional reconstruction is required.

8. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure is repeated by another physician on the same day. This could occur in a multi-disciplinary approach to jaw reconstruction.

9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Applied when the patient requires a return to the operating room for a related procedure during the postoperative period.

10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

11. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was necessary for the procedure. This is common in complex surgical reconstructions.

12. Modifier 81 (Minimum Assistant Surgeon): Used when an assistant surgeon is required for a minimal portion of the procedure.

13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary, and a qualified resident surgeon is not available.

14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician practitioner assisted in the surgery.

These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and appropriate reimbursement.

CPT Code 21244 Medicare Reimbursement

Medicare reimbursement for CPT code 21244, which pertains to the reconstruction of the lower jaw, depends on several factors including medical necessity, the setting in which the procedure is performed, and the specific Medicare plan. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting. However, if the procedure is performed in an inpatient setting, Medicare Part A may provide coverage.

The reimbursement amount can vary based on geographic location, the specific Medicare Administrative Contractor (MAC), and other factors such as the complexity of the case. As of the latest available data, the national average reimbursement rate for CPT code 21244 under Medicare Part B is approximately $1,500 to $2,000. It is important to verify the exact reimbursement rate with the relevant MAC and ensure that all necessary documentation and pre-authorization requirements are met to facilitate smooth reimbursement.

For the most accurate and up-to-date information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) and their local MAC.

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